Citation Nr: 0112114
Decision Date: 04/27/01 Archive Date: 05/01/01
DOCKET NO. 00-17 215 ) DATE
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On appeal from the
Department of Veterans Affairs Medical and Regional Office
Center in Sioux Falls, South Dakota
THE ISSUE
Entitlement to reimbursement for or payment of the expenses
incurred in connection with unauthorized medical services
rendered at Rapid City Regional Hospital from September 29,
1999, to October 4, 1999.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
Carole R. Kammel, Counsel
INTRODUCTION
The veteran served on active duty from March 1967 to October
1969.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a decision of the Department of
Veterans Affairs (VA) Medical Center (MC) in Fort Meade,
South Dakota.
Although the veteran requested in his Notice of Disagreement
that he be scheduled for a personal hearing, he subsequently
withdrew this request.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran's claim has been obtained by VA.
2. The veteran's treatment at Rapid City Regional Hospital
from September 29, 1999 to October 4, 1999, was for heart
disability.
3. Service connection was not in effect for heart disability
in 1999 and is not currently in effect for heart disability.
4. The heart disability treated during the hospitalization
in September and October 1999 is not a disability associated
with and held to be aggravating an adjudicated service-
connected disability.
5. The veteran's total rating based on unemployability due
to service-connected disabilities became effective in January
2000; the combined schedular evaluation for the veteran's
service-connected disabilities in effect for September and
October 1999 was less then 100 percent.
6. The veteran was not a participant in VA rehabilitation
program in September or October 1999.
CONCLUSION OF LAW
The criteria for payment or reimbursement of the medical
expenses incurred in connection with unauthorized medical
services rendered at Rapid City Regional Hospital from
September 29, 1999, to October 4, 1999, have not been met.
38 U.S.C.A. §§ 1710, 1728 (West 1991 & Supp. 2000); Veterans
Claims Assistance Act of 2000, Pub. L. No. 106-475, § 4, 114
Stat. 2096, 2098-99 (2000) (to be codified as amended at 38
U.S.C. § 5107); 38 C.F.R. §§ 17.120 and 17.121 (2000).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Initially, the Board notes that during the pendency of the
veteran's appeal but after the veteran's claim was most
recently considered by the MC, the Veterans Claims Assistance
Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096
(2000), became law. The VCAA eliminates the requirement that
a claimant submit evidence of a well-grounded claim, and
provides that VA will assist a claimant in obtaining evidence
necessary to substantiate a claim but is not required to
provide assistance to a claimant if there is no reasonable
possibility that such assistance would aid in substantiating
the claim. The VCAA also includes new notification
provisions. Specifically, it requires VA to notify the
claimant and the claimant's representative, if any, of any
information, and any medical or lay evidence, not previously
provided to the Secretary that is necessary to substantiate
the claim. As part of the notice, VA is to specifically
inform the claimant of which portion, if any, of the evidence
is to be provided by the claimant and which part, if any, VA
will attempt to obtain on behalf of the claimant.
The Board notes that all records pertinent to the veteran's
appeal have been obtained. In addition the veteran has been
informed of the requirements for the benefit sought on
appeal. There is no outstanding evidence which should be
obtained. Moreover, the pertinent facts in this case are not
in dispute and the law is dispositive. Consequently, there
is no further action to be undertaken to comply with the
provisions of the VCAA, and the veteran will not be
prejudiced as a result of the Board deciding this appeal
without first affording the MC an opportunity to consider the
claim in light of the VCAA.
In September 1999, the veteran was admitted to the Rapid City
Regional Hospital in Rapid City, South Dakota for chest pain
and shortness of breath after he had exercised. At admission
on September 29, 1999, it was determined that the veteran had
suffered from an acute anterior wall myocardial infarction.
At discharge on October 4, 1999, the final impression was
coronary artery disease manifested by anterior wall
myocardial infarction which was complicated by a secondary
ventricular fibrillation, age, hypertension and
hypercholesterolemia. A history of hypothyroidism status-
post ablation and hypertension were also recorded at
discharge.
The veteran contends that he is entitled to reimbursement for
or payment of the expenses incurred in connection with the
unauthorized medical services rendered at Rapid City Regional
Hospital from September 29, 1999, to October 4, 1999, because
the services were rendered in a medical emergency. The Board
believes that the hospital records and other evidence of
record support this contention.
However, to be eligible for payment of or reimbursement for
medical expenses incurred without prior authorization from
VA, the care or services must have rendered to a veteran in
need of such care or services (1) for an adjudicated service-
connected disability; (2) for a non-service-connected
disability associated with and held to be aggravating an
adjudicated service-connected disability; (3) for any
disability of a veteran who has a total disability permanent
in nature resulting from a service-connected disability; or
(4) for any illness, injury or dental condition in the case
of a veteran who is participating in a rehabilitation program
under 38 U.S.C. ch. 31 and who is medically determined to be
in need of hospital care or medical services for any of the
reasons enumerated in § 17.48(j). See 38 C.F.R. § 17.121.
The veteran has not been granted service connection for the
heart disability necessitating his hospitalization in
September and October 1999, the heart disability is not a
disability which is associated with or aggravating an
adjudicated service-connected disability, the combined
schedular evaluation for the veteran's service-connected
disabilities was less than 100 percent in September and
October 1999, and the total rating based on unemployability
due to service-connected disabilities now in effect did not
become effective until January 2000. These facts are not in
dispute. Since the pertinent facts are not in dispute and
the law is dispositive, the claim must be denied because of
the absence of legal merit. See Sabonis v. Brown, 6 Vet.
App. 426, 430 (1994).
ORDER
Entitlement to reimbursement for or payment of the expenses
incurred in connection with unauthorized medical services
rendered at Rapid City Regional Hospital from September 29,
1999, to October 4, 1999, is denied.
Shane A. Durkin
Member, Board of Veterans' Appeals